Bollensdorf A, Al-Madhi S, Meyer F, Pech M, Barth U, Halloul Z
Vascular surgical aspects in oncosurgery of the retroperitoneal space - series of representative cases
From the
- Division of Vascular Surgery; Dept. of General, Abdominal, Vascular and Transplant Surgery;
- Dept. of Radiology and Nuclear Medicine;
- Dept. of General, Abdominal, Vascular and Transplant Surgery; Otto-von-Guericke University with University Hospital, Magdeburg (Germany)
Corresponding address:
Dr. U. Barth, Division of Vascular Surgery; Dept. of General, Abdominal, Vascular and Transplant Surgery; Otto-von-Guericke University with University Hospital, Leipziger Str. 44, 39120 Magdeburg, Germany; phone: #49 391 67 15509, fax: #49 391 67 15570, email: Diese E-Mail-Adresse ist vor Spambots geschützt! Zur Anzeige muss JavaScript eingeschaltet sein.
Abstract
Aim: Exemplary demonstration of vascular alterations including its reconstructive options as part of retroperitoneal tumor(Tu) resections using an interdisciplinary surgical setting and team out of the broad oncosurgical profile to achieve R0 resection status, the most important prediction for curative intend of treatment.
Method: Representative case reports selected out of a consecutive case series over a defined observational period showing technical feasibility and, in some cases, early postoperative outcome of interdisciplinary operative management of the retroperitoneal tumor lesions. The cases are classified according to the type of the blood vessel attached/infiltrated/eroded as either arterial, venous or mixed, with particular focus on the operative maneuver in terms of photographically illustrated cases to emphasize the interdisciplinary surgical approach. A literature search was performed under www.pubmed.com, www.scholar.google.com, www.scienceirect.com and www.researchgate.com using the key words “vascular surgery”, “oncosurgery”, “retroperitoneal tumor lesions”.
Results (5 selective short case presentations out of the case series of n=14 over 10 years): 1) Preparatory freeing of a retropertoneal soft tissue sarcoma from adhesions to the aorta near the origin of the superior mesenteric artery and coeliac trunk as part of a multivisceral resection including left resection of the pancreas (+splenectomy, left nephrectomy) / partial resection of the stomach and diaphragm (+ thoracic drainage and suture of the intestinal wall).
2) In-toto exstirpation of a well differenciated retroperitoneal leiomyosarcoma of the inferior vena cava including tangential resection of its wall due to tumor infiltration and subsequent patch plasty (lyophilized calf pericard; Vascutek Dtl. GmbH, Hamburg, Germany).
3) Pancreatic head resection in a 45-year old patient with arterial supply from the superior mesenteric trunk via (so-called) hepatomesenteric trunk, which was only realized after ligation of the gastroduodenal artery – vascular reconstruction by mesentericohepatic venous bypass.
4) Tumor exstirpation of a retroperitoneal neurinoma (right side), with tumor-associated adhesios to the inferior vena cava, common iliac artery and psoas muscle with no required vascular reconstruction.
5) Tumor resection of a primary inferior-vena-cava sarcoma with i) segmental resection of the vena cava including the mouths of both renal veins and ii) segmental reconstruction of the resected inferior vena cava using ringed PTFE prosthesis (Ø: 20 mm) as well as iii) reimplantation of both renal veins (Dacron prosthesis for the left vein; right, genuine vein).
Discussion: Altogether, 14 patients of this rare coincidence of retroperitoneal tumor lesion with vascular alteration are demonstrated through the presented study, with the highest portion of tumors originating from retroperitoneal organs followed by those of primitive mesenchymal retroperitoneal tumors. Variable vascular surgical repair / reconstruction methods (direct sutures / patch plasty / interposition or bypass graft) are varyingly used depending on the severity, length and venous or arterial site of alteration.
Retroperitoneal tumors with vascular invasion/infiltration are mostly malignant tumors, which vary in histological nature and which can be subdivided in either primary or secondary tumors. Vascular alteration can be classified in simple attachment or adhesion, partial wall infiltration or complete erosion of the blood vessel by the tumor.
Conclusion: Vascular alteration is an important issue in radical oncological surgery, in particular, in advanced tumor growth. In addition to vascular resection to achieve R0 resection for a better prognosis, variable vascular reconstruction is necessary, which requires surgical expertise including interdisciplinary partners, such as interventional radiology for complications and specific problems and intensive care for competent perioperative management, urology and gynecology for tumor lesions originating from urogenital organs.
Key words: Vascular surgery, Onco-(logical) surgery, Retroperitoneal tumor lesions